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Salmonella Bacteremia in Kenyan Children

Brent, Andrew J. MRCP*†; Oundo, Joe O. PhD*; Mwangi, Isaiah MTropPaeds*; Ochola, Lucy PhD*; Lowe, Brett MPhil*; Berkley, James A. MD*†

Pediatric Infectious Disease Journal:
doi: 10.1097/01.inf.0000202066.02212.ff
Original Studies
Abstract

Background: Nontyphoidal Salmonella spp. are among the leading causes of childhood bacteremia in sub-Saharan Africa, yet there are few published clinical series, and the risk factors for acquiring infection are not fully understood.

Methods: We examined data from 166 cases of nontyphoidal Salmonella bacteremia identified during a large prospective study of bacteremia among all children admitted to a district hospital in Kenya. We also investigated the importance of comorbidities, including current malaria parasitemia, recent malaria (detectable Plasmodium falciparum histidine rich protein 2 in the absence of parasitemia), sickle cell disease, malnutrition and human immunodeficiency virus (HIV) infection.

Results: Nontyphoidal Salmonella bacteremia was associated with severe malnutrition (33% cases), HIV infection (18% cases), a history of illness >7 days, recent hospital admission, splenomegaly, anemia and recent (but not current) malaria but was not associated with diarrhea. Seventy-seven (46%) children with nontyphoidal Salmonella bacteremia fulfilled World Health Organization clinical criteria for a diagnosis of pneumonia. Independent risk factors for death were diarrhea, tachypnea, HIV infection, severe malnutrition, meningitis and young age.

Conclusions: Clinical diagnosis of invasive nontyphoidal Salmonella infection in African children is difficult without microbiology facilities because clinical features overlap with other conditions. The common risk factors for nontyphoidal Salmonella infection differ from developed countries, with high a prevalence of malnutrition, HIV, malaria and anemia. Children with nontyphoidal Salmonella infection who fulfill World Health Organization clinical criteria for severe pneumonia may receive ineffective therapy in the form of penicillin.

Author Information

From the *Wellcome Trust/KEMRI Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; and the †Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, United Kingdom

Accepted for publication October 28, 2005.

This study is published with the permission of the director, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.

Supported by KEMRI and by the Wellcome Trust of Great Britain. A. J. Brent held a Wellcome Trust unit visitors grant, J. A. Berkley held a Wellcome Trust training fellowship (053439). The funding source had no role in the study design, implementation, analysis, manuscript or decision to publish.

Address for reprints: Andrew Brent, Flat 20/2, Chartwell House, Old Road, Headington, Oxford OX3 7LJ, UK. Fax 0044-1865-764192; E-mail andrew_brent@doctors.org.uk.

© 2006 Lippincott Williams & Wilkins, Inc.